Terrible clinical day, nurses don't seem to care. - page 9

I may get a lot of flack for this from the more experienced nurses, but I would like some help in understanding this situation. Today, I walked by a patient's room in the hallway. Keep in mind... Read More

  1. by   suzy253
    Absolutely brilliant, Roy!!! thanks
  2. by   ktwlpn
    Your post illustrates what I see as a systemic problem. Babies,children,cancer patients,head trauma victims etc. all receive specialized care-why not the elderly? Where are the units with the required specialized staffing for them? I'll tell you-they closed because they lost money..I have hope that the baby boomers will change this ...Roy's post is great-it explains what can happen to a patient like this-until you have restarted an IV 23 times in 4 days on a confused LOL you can't understand how frustrating it is.Even JCAHO has refused to acknowledge the problem... If an elderly person developes a pressure ulcer in LTC it's sentinel event- and you can be citied..if it happens during a hospital stay it was considered acceptable (I don't know what the latest regs are) The goal in med surg is getting out fast and alive and that's hard on the elderly. There is not enough staff to feed,turn and re-orient..Sitting them at the nurse's station is awful-no dignity there.What do you do when the facility has no funds for sitters and the family does not or cannot attend to their loved one? I think your niche may be in geriatrics-I love it and seem to have endless patience.I can get the most confused and agitated resident to take meds,accept redorection and direct care.I't a knack I have...The LOL I mentioned before-the one that pulled out her IV over and over again-I wrapped her wrist with kling and wrote with black marker " Doctor says do not touch this" Guess what? -it worked...It was a shame that I had not had her before she went through all of those sticks...
  3. by   Koyaanisqatsi-RN
    Quote from lamazeteacher
    Who said you can't look at her chart, because she wasn't "your patient"?
    We were told very clearly that we can not look at the chart of patients who are not ours. We were told it was a HIPAA violation.
  4. by   Rascal1
    Quote from ooottafvgvah
    We were told very clearly that we can not look at the chart of patients who are not ours. We were told it was a HIPAA violation.
    Wow that's news to me...
  5. by   cherrybreeze
    Quote from Rascal1
    Wow that's news to me...
    I'm confused on why that would be news to anyone. If you're not directly involved in a particular patient's care, you don't have the right to their info. That's one of the most fundamental rules OF HIPPA....
  6. by   cherrybreeze
    Quote from nursemike
    This is a very good question. For starters, I think if you find yourself in a situation where you have to vent a lot, you're probably in the wrong situation. A little griping and grumbling may not be such a big deal--I call it an important part of the healthcare-worker bonding process. Some of my favorite coworkers, mostly very good nurses, have a rather sardonic sense of humor. But if you are seriously frustrated on anything near a daily basis, it's likely time to do something else. It could mean one is just not cut out for nursing, but I think it's more apt to be you're in the wrong unit, or facility.
    I think it's prudent to be concerned that cussing and kicking the med cart may be reflected in how we treat our patients. Those who most believe they are as sweet as can be to the patient's face, no matter how badly they feel toward the patient, may not be quite the actors they suppose they are. I think most of us are pretty good at distinguishing someone who is seriously interested in our well being from someoone who pretends to care.
    Even very confused patients aren't necessarily stupid, and a lot of times they don't have much else to do than observe their caregivers.
    On the other hand, I once described a unit clerk as being like your mom: she'll drive you nuts, but you gotta love her. And I think that's typically true of our loved ones--we don't always get along, all the time, but we love each other even when we're annoyed. Personally, I find that to be true of patients, as well. I don't stop caring about them, even when they get on my nerves. And it might appall any nurse managers reading this, but I don't even think it's necessarily wrong to let a patient see that they're getting on your nerves, as long as they can still see that you genuinely care about them.
    But on yet another hand, I think we need to be careful not to let our occassional gallows humor and/or venting condition us to become heartless. Call someone a "crazy old lady," often enough, and you could just start to really see them that way. And, as the OP demonstrates, it doesn't look very good to others who may not share the same jaded mentality.
    One of my touchstones has been that nursing is a human endeavor. It was pretty clear to me before I ever got out of orientation that I was never going to be Supernurse. If I have to place a Foley in a female, especially one my age or younger, it makes me a little uncomfortable. I'm simply not able to carry off the impression of a consumate professional who has done this a thousand times, so I settle for looking like what I actually am, a decent guy trying to perform an awkward task with the least necessary fuss. Similarly, if a patient wants an extra blanket during my 2200 med pass, I get it. If they then ask for ice water, I get it. If they then say, "I hate to be a bother, but can I have some pain meds?" I don't tell them it isn't a bother, unless it truly isn't, but I probably will say something like, "That's okay, they pay me to do this," or possibly even "they pay me to put up with you." And sometimes I recognize that people who are on the call button a lot may just be lonely, so when I have a little time, I'll just pop in to hang out with them. I hope that isn't coming across as too saintly, because I probably will also report to the nurse that follows me that the patient is "needy," or "kind of a PITA."

    To summarize, you don't necesarily have to be hypocritical to be a good nurse. Sometimes schizophrenia works just as well.
    I was the one that mentioned the *gallow's humor* aspect, but much of what you described here also describes howI practice. Ironic, yes? A little actual humor in dealing with your patients goes a heck of a long way, I find (once you suss out which ones can deal with it, and how). I love to pop in and "hang out" for a few minutes, if time allows. If I have someone who frequently is asking for warm blankets, I'll try to offer the next one before they ask....same with pain meds, or whatever else the frequent request may happen to be. One of my favorite sayings to patients is, "if this is the worst thing that happens today, it's been a pretty good day" whether they've just dumped their lunch tray or didn't quite make it to the bathroom in time. The relief on their faces is priceless. So, I wouldn't say I've let it make me become heartless by any stretch of the imagination. I like to think the opposite.
  7. by   hikernurse
    Quote from cherrybreeze
    I was the one that mentioned the *gallow's humor* aspect, but much of what you described here also describes howI practice. Ironic, yes? A little actual humor in dealing with your patients goes a heck of a long way, I find (once you suss out which ones can deal with it, and how). I love to pop in and "hang out" for a few minutes, if time allows. If I have someone who frequently is asking for warm blankets, I'll try to offer the next one before they ask....same with pain meds, or whatever else the frequent request may happen to be. One of my favorite sayings to patients is, "if this is the worst thing that happens today, it's been a pretty good day" whether they've just dumped their lunch tray or didn't quite make it to the bathroom in time. The relief on their faces is priceless. So, I wouldn't say I've let it make me become heartless by any stretch of the imagination. I like to think the opposite.
    I agree, Cherry. Laughing at something in private sometimes gives us the only control we have over a situation that's too hard to face straight on. It sure doesn't make me less likely to care about my patient; in fact, it can give me enough distance to be a good caring nurse. I know it doesn't lessen my ability to cry with a mom after she's heard bad news about her baby. If we had to internalize everything we face at work on a daily basis, I don't think we could last more than a few shifts. Gallows humor is sure hard to explain to people who work out of our business, but it can be a very effective way to cope.
  8. by   Rascal1
    Quote from cherrybreeze
    I'm confused on why that would be news to anyone. If you're not directly involved in . particular patient's care, you don't have the right to their info. That's one of the most fundamental rules OF HIPPA....
    Many health professionals that do not take care of them directly, still may need access to the patients' charts. As a few examples... Utilization review,Discharge planners,MDS. coordinator,Unit manager,any other nurse who is aiding the primary nurse or the patient. Just to name a few..
  9. by   wooh
    Quote from Rascal1
    Many health professionals that do not take care of them directly, still may need access to the patients' charts. As a few examples... Utilization review,Discharge planners,MDS. coordinator,Unit manager,any other nurse who is aiding the primary nurse or the patient. Just to name a few..
    Nursing students wouldn't fall on that list.
  10. by   Rascal1
    Quote from wooh
    Nursing students wouldn't fall on that list.
    Students could very well have reason to peruse a patient chart,but appararently not this particular student.:icon_roll
  11. by   Koyaanisqatsi-RN
    Quote from Rascal1
    Students could very well have reason to peruse a patient chart,but appararently not this particular student.:icon_roll
    I think the point is, my being curious about this patient's condition is not enough to warrant me digging around in the chart. Especially when an MD or other nurse might need it. That's in addition to it violating HIPAA.
  12. by   wooh
    Quote from Rascal1
    Students could very well have reason to peruse a patient chart,but appararently not this particular student.:icon_roll
    Since this particular student wasn't caring for this particular patient, then there was no reason for this particular student to look at this particular patient's chart. Being in the building doesn't give anybody, even a nursing student, the right to look through any chart in the building. If I'm caring for the patient, then I can look through the chart. If my coworker asks me to give a med to one of their patients, I can look through the chart. If I'm a case manager or auditing charts or for whatever reason being paid to be in the chart, I can be in the chart. If I'm in a chart though, I better have a legitimate reason for it. I should err on the side of caution when it comes to accessing a chart. And if I'm a nursing student, a guest in the facility who desperately wants to pass my class and get a license of my very own, then I'd DEFINITELY better err on the side of caution and stay out of any charts that my instructor/preceptor doesn't make clear that I'm allowed to look at.
  13. by   Rascal1
    Quote from wooh
    Since this particular student wasn't caring for this particular patient, then there was no reason for this particular student to look at this particular patient's chart. Being in the building doesn't give anybody, even a nursing student, the right to look through any chart in the building. If I'm caring for the patient, then I can look through the chart. If my coworker asks me to give a med to one of their patients, I can look through the chart. If I'm a case manager or auditing charts or for whatever reason being paid to be in the chart, I can be in the chart. If I'm in a chart though, I better have a legitimate reason for it. I should err on the side of caution when it comes to accessing a chart. And if I'm a nursing student, a guest in the facility who desperately wants to pass my class and get a license of my very own, then I'd DEFINITELY better err on the side of caution and stay out of any charts that my instructor/preceptor doesn't make clear that I'm allowed to look at.
    No,of course not, just being in the building does'nt give anyone or a student permission to access a patient chart. How ridiculous !

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